Arthroscopic Treatment of Combined Anterior and Posterior Cruciate Ligament Avulsion Fracture: A Case Report.

Anterior cruciate ligament (ACL) avulsion fractures without any concomitant injuries are extremely rare in skeletally mature patients and sporadically reported in the literature. Such injuries are more likely to be associated with tibial plateau fractures, other knee ligament ruptures, distal femoral fractures, or knee dislocations. In this article, a case of a 55-year-old male, who suffered a combined displaced ACL-posterior cruciate ligament (PCL) avulsion fracture, without any related injuries, is reported. The fracture was treated all arthroscopically with both an internal fixation and a single-tunnel suture fixation. In this case, arthroscopic anatomic reduction and internal fixation of the displaced tibial eminence was achieved, and internal fixation was performed with two antegrade cannulated screws with additional single-tunnel trans-ACL suture fixation. Six months post-injury, the patient had no signs of post-traumatic osteoarthritis, restoration of range of motion, no pain, and no residual instability of the knee joint. The mechanism of this rare injury, the method of fixation that was used, and the rehabilitation protocol that was followed are demonstrated. Additionally, the clinical outcome in terms of certain parameters is evaluated. Finally, we highlight the importance of this method for additional strength of fixation and the role of early mobilization to establish satisfactory results.